COMMENTARY

The Human Tales That Keep Me Practicing Medicine

John Mandrola

Disclosures

January 21, 2015

It is the stories, isn't it?

Hardly a day goes by that I do not find a story worth remembering. Medicine is that way.

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An elderly caregiver, sick herself, entombed in life, her husband with dementia. Atrial fibrillation is a heart-rhythm disease one sees on an ECG. But you can almost see it in her face. How could her heart not fibrillate? You can see her exit. She cannot. She will not. Her job—not done.

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A different patient. Dementia again. Darn it. Again you can see the diagnosis in the face. His was a blank stare, not so much tension, but no less strange for a man of details—an engineer. His notebook once filled with questions: Why does the heart do these things? How does ablation work? How do you know where to put the catheter? A decade later, this man you know well just stares at you, or is he looking through you? AF is the least of his troubles now. Trembling hands and spoon-feeding are the problems of today.

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You walk through the door and see a different person. Thinner cheeks, brighter eyes, an absent belly are the cursory observations. Pride is the obvious thing. "Your prescription worked. I changed my priorities." You feel a wave of emotion. You did this with words, not pills or procedures.

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Struggles with meandering electrical circuits in the EP lab hardly make for a compelling story. But later, say 6 years later, the grandmother brings her grandchildren to the office. She, and her regular heart rhythm, are strong enough to care for them. You recall the struggle, the changing vectors of the many rogue circuits. You feel it again, another wave of emotion.

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Then there are the doctors. Human doctors, I mean. Most of them are kind, hard-working, prideful, and committed to making other people well. Their peg is your goal—health. These are hard times for the human doctors, especially those attached to a time passed. Managing gracefully is no small thing: Nolite te bastardes carborundorum (Don't let the bastards grind you down). Maybe they will. Maybe they have.

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"Did you discuss your goals of care with your family doctor?" "He is gone. I go to the urgent-care center now."

"What about your cardiologist?" "He is with a new hospital. My insurance does not cover that place."

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A new day comes. More stories. More chances to manage gracefully.

The heart is easy. The other stuff, not so much.

JMM

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